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Individual

ANTHONY VITALI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
516 E. NIZHONI BLVD, BOX 1337, GALLUP, NM 87301-1337
(505) 722-1000
(505) 722-1565
Mailing address
516 E. NIZHONI BLVD, PO BOX 1337, GALLUP, NM 87301-1337
(505) 722-1000
(505) 722-1565

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS028849L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000T4892
NM
05
440975
AZ
Enumeration date
06/29/2006
Last updated
04/11/2008
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